Chair of DSM-5 Task Force Responds to NIMH

David Kupfer, Chair of the DSM-5 Task Force, while defending the DSM as a useful diagnostic tool in a press release, concedes that “biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity” are still “disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.

A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.

Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.

Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.

A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

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35 COMMENTS

“We’ve been telling patients for several decades that we are waiting for biomarkers.”

Oh that is B.S., psychiatrists have been telling patients and their families for decades that biomarkers have been found, that this or that “disease” is caused by brain malfunctions, genetic in origin, etc. Every time I get blood work my doctor gives me one of those slips that have all the tests on it and he just fills in the boxes for the ones I need, and right there on the slip I see a section for “neuropsychiatric” test including “depression” and “schizophrenia”, as a result I’ve come across many arguments on the internet in which people smugly tell me that there “is in fact” a test for these “diseases”

If these people are going to try backing away from this now, refusing to admit culpability in what they’ve done… That just goes too far.

I mean, seriously. How many parents would have actually drugged their children if the psychiatrists had been being honest?

“Oh, we don’t really know if there is anything wrong with your kid, and if there is we have no idea what it is. But give him this psychotropic drug anyway, it cant possibly be fixing anything that’s wrong with him, if there is even anything wrong with him at all, we really don’t know.”

Yeah, I’m sure that would have gotten millions of kids forced on psychotropic drugs.

We have people in America today who are blathering on about reparations to African Americans for slavery, which ended in 1865. Nobody alive today has ever been a slave, bought and sold on the block, in America.

If reparations for Slavery are in order, they should be coming from the Drug Makers and Sales people of Psychiatric Diagnosis and Drugs, TO, the victims of their unlawful chicanery along with the restitution of those stolen Rights.

This country doesn’t seem to give a rat’s hind foot about Civil Rights anymore, and it appears that the concerns who’ve Bought this Scam won’t halt it until it simply Costs them More in Damages than they stole from Medicare, Medicaid, Private Insurers and Citizen’s pockets to begin with.

How about Monetary Reparations from PhARMA and the APA for violating the 13th Amendment?

Like others here, I find the latest lies of the mental death profession truly despicable. They have been lying for decades that bogus VOTED IN stigmas like bipolar, ADHD, depression and others used to make a literal killing with BIG PHARMA to create and push the latest lethal drugs on patent are biological, genetic, chemical brain imbalances and most recently faulty brain wiring. This sordid “profession” created its junk science DSM to puff itself up with the pretense of being real medical doctors as Freudian analysis waned to con others with a fraudulent pretense of science and brain expertise. One can see that such fraud could only lead to the massive evil and harm against millions of people these criminals perpetrated in the guise of science and “mental health.” It is worse than any other human holocaust given that nobody on the planet from cradle to grave is safe from their greed, lies and predation.

The latest ploy of the never ending quest for the holy grail of genes or other evidence to continue preying on and destroying vulnerable people who are an inconvenience to the more powerful in the therapeutic state in the guise of medicine is nothing new. Obviously, psychiatry is just one arm of our increasing fascist police state except they used life destroying stigmas and lethal brain/body damaging drugs to eliminate any opposition or any behavior that differs from the robotic nature of these psychiatric predators agenda. Reading the above release about the DSM 5 and the pretense that it has anything to do with helping so called patients is such a vicious, self serving lie, it boggles my mind. Though many are on to these never ending lies from the “boys who keep crying wolf” in the mental death profession, the majority of people prefer to keep these thought police in power to be able to demonize and eliminate their perceived enemies.

Insel and his equally dishonest DSM cohorts that oneboringoldman exposes as a long term corrupt bogus agenda will continue the bogus lie of biopsychiatry while ignoring all toxic social stressors to keep the gravy train going for these hacks at the top of the food chain calling the shots serve those in power while continuing to blame their victims. It’s also been pointed out that Insel and others are hoping to get their hands on money Obama plans to spend on more bogus research with the pretense this will stop school and other public shooters most of whom were under great psychiatric treatment and drugging.

Check out Insel’s corrupt relationship with Charles Nemeroff cited by Senator Grassley for being a BIG PHARMA KOL taking drug company money on the sly while supposedly working on government grants that disallowed such hidden conflicts of interest.

Here is a more lighthearted article about the neverending bogus claims made about the brain made to appear scientific by adding neuro this and neuro that just as Insel has done with his bogus neuroscience label for the latest bogus biopsychiatry eugenics agenda to cover up for all the misery, harm, oppression, greed, exploitation and evil done by the current robber barons of the power elite preying on the rest of us.

Yes. Thomas Szaz always stated that psychiatry is an arm of the government which the government uses to keep people in line and controlled. This is certainly the case with African Americans, especially African American males starting in the early ’70’s when the government realized that African American people were angry about their treatment. Szaz was saying this years and years ago but no one wanted to listen to this and now, consequently we have all of the forced treatment laws in a majority of the states in this country.

I still have not quite worked out what biomarkers they are actually looking for. In order to find a biomarker for something that something actually has to exist. They have found biomarkers for other things, because they knew exactly what it was they were trying to find a biomarker for. Ie, they knew exactly what Down Syndrome was and so could very easily find a biomarker and what happens in the condition.

Since they still cannot agree on what any of these bogus disorders are, how do they propose to find biomarkers for it. I mean the ones they are currently searching for will be totally invalidated come the 1st of July, when the DSM 5 comes out with new criteria for everything. The disorders they are seeeking biomarkers for at present, will not exist on the 1st of July. They might have some bogus condition with the same name, but the criteria for being diagnosed with it, will have changed, so people will have to be relabled with something totally different in many cases, so the biomarkers will surely have also changed!???

Still trying to work out how these idiots made it out of kindergarten, let alone became doctors and scientists with university degrees!!

They don’t care so much about finding biological markers for their evil eugenics agenda, but rather continuing to come up with the latest pseudoscience with neuro in front of it to give the little people the delusion/illusion that they are doing anything but serving as an arm of an increasingly fascist police state in the guise of mental health to rob any inconvenient person or dissident of all human, civil, democratic rights and due process as they have been doing all along just like Stalinist Russia they had the gaul to condemn while doing the exact same thing in the so called land of the free as does Britain and other pretend democracies.

See Joanna Montcrieff’s article on the web, PSYCHIATRIC IMPERIALISM: THE MEDICALIZATION OF MODERN LIVING.

Bob Whitaker has a great post on his blog on how biopsychiatry created a mass societal delusion with its bogus brain chemical imbalance lie they knew was fraud but pushed it anyway with BIG PHARMA to push more stigmas and lethal drugs. Bob exposes the bogus anti-stigma campaigns as fraudulent since the biopsychiatry lies that so called mental illnesses are brain diseases or biological are the cause of all the fear, ostracism and contempt aimed at those stigmatized as “mentally ill.” He also points out that such stigma is not so prevalent when people are made aware that social stressors and normal human setbacks can cause the type of emotional distress psychiatry stigmatizes falsely as diseased brains. Bob smartly points out that all the stigma could end if psychiatry just told the truth. But, as we all know, the truth will never be set free by psychiatry nor will the truth set free their many victims unless they fight for it themselves!

“The American Psychiatric Association is a national medical specialty society whose physician members specialize in diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders.”

For those of us who have gone through a diagnosis process, the lack of science during the process is appalling – a series of questions about mood and symptoms. And yet, studies do show a basis for depression in the body – overactive left prefrontal cortex in fMRI, elevated levels of stress hormones like cortisol, a shrunken hippocampus, possibly (controversially) something wrong with serotonin levels, a gene that has been linked to depression. And yet, there are no blood tests, lab procedures, or brain scans to diagnose depression. I congratulate Dr. Insel for turning research in a new direction.

I would submit that studies have not shown A basis for depression in the body, they have shown LOTS of possible correlations for depression, because, as Dr. Insel himself just said, “depression” isn’t a thing that has a cause. It’s a set of symptoms that could have dozens or hundreds of causes, some of which aren’t “illnesses” or “disorders” or pathological in the least.

To try to reduce depression, which is clearly a biologically appropriate state with important survival value to the species, to a “mental disorder,” without consideration of how, why or when this “depression” occurs is quite irrational and of course, will never lead to any meaningful results.

I’m glad Dr. Insel has made this observation publicly. Unfortunately, his new path is still based on the assumption that genetic causes are primary and will be found. Common sense should direct us to look at a much more subtle and complex interaction of genetics, experience, and environment to understand each individual’s emotional responses in a much more nuanced way.

Psychiatry is like doing surgery with a claw hammer. The instruments are so crude, they can do nothing but make the situation worse.

No one can ever have what psychiatry labels as a normal brain, and MOST of the changes identified, have bee in people on medications, and it is the medications causing the problems. There has never been aything found in a child with ADHD that was not purely accountable for with medication, take them off the medication or test them for everything under the sun before medication and nothing at all is found.

Cortisol is not bad. We all need certain levels of it to survive. Stress is an essential part of life, and I for one would not wish my life to never have any in it. Sure in excessive amounts it can become tiring, but there are very simple environmental and natural ways of achieving that, and toxic brain drugs and electricity in the brain are not and never will be some of them.

Stress is a part of life. I have had more than my share of it. I was raised in a pedophile ring, I know what bad stress is. But to say that I should do away with the day to day stresses of life, that make me human is stupid. If I can’t cope with a bus running 5 minutes late, getting wet when it rains, because I left my umbrulla at home, having to go back to the grocery store because I forgot to buy something, I hardly think some toxic pill that has as its primary side effect, suicidal thoughts and feelings is going to help me.

Psychiatry cannot even define what it is they are trying to achieve. They say that stress is bad, but life is stress. What do they propose, we euthaise the whole population. And of course if we need to alleviate stress, then getting rid of there barbaric treatments and side effects, the court orders that treat us like criminals for experiencing normal human emotions and labelling us as defective for life on the basis that we cry for 2 weeks after loosing a partner of 50 years is more stressful than the day to day life stresses they say we cannot cope with!!!

Nothing in psychiatry helps anyone, they do however make the lives of everyone they come into contact with signficantly worse.

Your point about not looking at depression through a biological lense only is an important one. The new NIMH approach to grounding depression diagnosis in evidence-based studies of biology is a very important next step – and yet it remains incomplete. If the study of depression stays stove-piped within disciplines, even an important one such as biology, without incorporating studies of (a) the mind and thinking habits and (b) stressful circumstances in our environment, then we are still aiming for an incomplete solution. From a policy perspective, perhaps the NIMH can take their initiative the next step and develop a wholistic, evidence-based approach to defining and diagnosing mental health that includes the body, the mind, and circumstances.

They’re not going to find their causes for madness in biology! This is all a waste of time and effort, which could be applied towards truly helping people in distress and emotional pain. Instead, they keey beating this dead horse of biology as the cause for our experiences of madness!

Very true Stephen Gillbert, but they would not be doctors if they did not have biological diseases to treat and physical treatments to treat the diseases with!! I think this search for a biological cause is as much about them needing to be seen as real doctors, as it is about believing it. I think many of them do know that nothing will ever be found, but to admit that will admit that they are not real doctors and they will never do that!!

The fact remains that if there was any biology in madness it would have been found long ago. From the dawn of time they have been chopping open the brains of people who were supposedly mad, and they never found anything. Only when they started loading people full of toxic drugs did they suddenly begin to find things, things that are never found before people are drugged to the eyeballs and changes that occur in line with the dosage and the length of time on the drugs. Yet they still claim the drugs do no damage and instead treat some fictional disese.

I commented on MIA’s facebook page that many psychiatrists seem to be shirking the evidence that the truth of their inner lives can be made known. (It reminds me of Frank Drebin waving his arms, claiming, “Nothing to see here!” in Naked Gun.) They don’t mention that lots of data shows symptoms of disorders occur when brainwaves are unbalanced. They’re relieved when brainwaves are balanced, which is often rather easily done. (brainstatetech.com — I’m not paid to share this.) If they can’t seek and embrace technology that can help them perform better, are they over-controlling the profession themselves? I cited a biomarker (or bio-correlate) for remorselessly over-controlling behavior on facebook.

I don’t know why I have Allen Frances in my RSS feed. I usually collect good stuff to my RSS feed. I don’t even know who he is. Sometimes, though very rarely, I pick out RSS feeds that are inane, so that I can track what they are writing. Maybe this is what I get.

“So what is a patient or potential patient or parent to make of the confusing struggle between NIMH and DSM-5 debacle?

…

My advice is to ignore it. Don’t lose faith in psychiatry, but don’t accept psychiatric diagnosis or treatment on faith — particularly if it is given after a brief visit with someone who barely knows you. Be informed. Ask lots of questions. Expect reasonable answers. If you don’t get them, seek second, third, even fourth opinions until you do.

A psychiatric diagnosis is a milestone in a person’s life. Done well, an accurate diagnosis is the beginning of increased self understanding and a launch to effective treatment and a better future. Done poorly it can be a lingering disaster. Getting it right deserves the kind of care and patience exercised in choosing a spouse or a house.

Remember that psychiatry is neither all good or all bad. Like most of medicine, it all depends on how well it is done.

Allen Frances”

…

I think that the important message is that you “Don’t lose faith in psychiatry”!!

I don’t why I’ve subscribed to this RSS, but I think it was to follow senile old men in their degeneration to nothing.

“The psychiatric association’s diagnoses are mostly based on a professional consensus about what clusters of symptoms are associated with a disease, like depression, and not on any objective laboratory measure, like blood counts or other biological markers. The mental health institute says scientists have not produced the data needed to design a system based on biomarkers or cognitive measures. ”

But then, it concludes by saying,

“Consensus among mental health professionals will have to suffice until we can augment it with something better.”

For a newspaper that has made advancing gay rights one of its core values it is very disturbing that they are appealing to the type of consensus that in the past pathologized homosexuality. It is always easier to demonize past injustices than current ones. There is not the slightest shred of evidence that any of the DSM invented diseases are real, biologically speaking. Yet they are endorsing the practice of labeling “mad” those who deviate from behaviors defined as “normal” by a group of self appointed mind guardians. Hasn’t the West been there before with the Inquisition?

Couldn’t agree more Duane. History in the making is right. It reminds me of when the Berlin wall fell, and how quickly the other communist countries followed.

Think about this, 2 weeks ago, we were all (at least I was) in the mood of fighting psychiatry as some kind of ongoing struggle, now after the moves by the NIMH and the British Psychological Society there is a real possibility that we will see psychiatry stripped of its status as a legitimate branch of medicine in our lifetimes, probably sooner than later. Exhilarating is the word that comes to my mind 😀 !!!

Just because I don’t believe in the simple “chemical imbalance” theory; nor the horrible “treatments”, doesn’t mean that I don’t believe that human suffering is very *real*, especially, the suffering of the human soul.

I happen to think we can treat this suffering in more holistic and more humane ways. And we can witness enormous growth and transformation as a result, the likes of which we cannot imagine!

I think that most agree with you here. Even Scientology agrees that human suffering is real. That was never the question, me thinks.

The question was that a pseudoscientific discipline was sold as a solution to these problems that could be “forced” into people, whose ability to inflict suffering into its victims was worse than the original suffering. It became some sort of an official religion with its own Inquisition. That was the real problem. In fact, I have never opposed those who voluntarily use its services, no more than I oppose people using the services of astrology or homeopathic medicine. It’s its status as a coercive force (justified on canards such as the “chemical imbalance”) that was always the problem.

I totally agree in relation to human suffering being rule and the fake science being the problem that has become a quasi religion. But I question whether it is just about force. Can anyone seriously make an informed decision about psychiatric treatment. People assume that if it is performed by doctors, that if it is paid for by governments or via health insurance of any sort it must be an acceptable and evidenced based practise. No health insurance whether government or privately funded funds astrology or homeopathic treatment, that I am aware of anywhere in the world. People are free to use it, but they do so of paying for it themselves.

Health Insurance, regardless of how it is provided funds insulin and test strips and the like for diabetics. It is believed that insulin treats diabetes and no one questions that. Likewise health insuracne funds these toxic pills labelled as anti everything and people assume on that basis that just like insulin for diabetes being funded it must be evidenced based.

No one can possibly do all there own research for every medical condition. If one is lying in a hospital bed barely alive after a heart attack, they can hardly do there own research and make a fully informed decision about what treatments to recieve or not to recieve. One does have to trust professionals at some stage.

And trusting professionals comes in all sorts of areas. Yesterday I had a new stove put in, as the other one had died. I had to trust that an electricion had installed it properly, because I am not an electrican. Yes, i made sure they were a licensed electrician and checked that not via them, but via the licensing register, but after that i do have to trust them. People similarly put there trust in doctors, because the fact is we all get sick at some stage and all require some sort of assistance. We trust that if someone is a licensced doctor they know what they are doing. And yes to some degree we can question those things, but there are times when we can’t. As a society we employ ambulance officers and we assume that they will be able to safely transport someone to hosptial, because we do not see it as appropriate to leave someone to rot and die on the side of the road.

No one can do everything, we all need help and assistance at some stage in our lives and we have professions to be experts in certain things and to assist us with those things. The problem is that psychiatry has become a profession that is promoted by government as real doctors, they are licensed as doctors and health insurance of any sort funds treatment by them. That is done on the belief that they are treating some real diseases. Problem is no one can make an informed decision to recieve treatment for something that does not exist. Does human suffering exist, sure, but one cannot treat it as though it is a disease.

When psychaitry is not treated as a medical specility, when it is not funded by health insurance, and not promoted as anything by anyone. Then and only then will people be able to make an informed decision about whether they want to use it or not.

In the US, some insurance companies pay for homeopathy (though not all).

On the rest, I agree, the ultimate goal is to have psychiatry achieve homeopathy status: it should have the legal status of a pseudoscience and be entirely voluntary for the people who want to use its services.